Acne vulgaris (acne) is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). It most often affects adolescents. Diagnosis is by examination. Treatment is a variety of topical and systemic agents intended to reduce sebum production, bacterial counts, and inflammation and to normalize keratinization.

Causes:

The most common trigger is puberty, when surges in androgen stimulate sebum production and hyperproliferation of keratinocytes. Other triggers include hormonal changes that occur with pregnancy or the menstrual cycle; occlusive cosmetics, cleansers, lotions, and clothing; and high humidity and sweating. Associations between acne exacerbation and diet, inadequate face washing, masturbation, and sex are unfounded. Some studies suggest a possible association with milk products and high-glycemic diets. Acne may abate in summer months because of sunlight’s anti-inflammatory effects.

Signs and symptoms:

Cystic acne can be painful; other types cause no physical symptoms but can be a source of significant emotional distress. Lesion types frequently coexist at different stages.

Comedones appear as whiteheads or blackheads. Whiteheads (closed comedones) are flesh-colored or whitish palpable lesions 1 to 3 mm in diameter; blackheads (open comedones) are similar in appearance but with a dark center.

Diagnosis:

  • Assessment for contributing factors (eg, hormonal, mechanical, or drug-related)
  • Determination of severity (mild, moderate, severe)
  • Assessment of psychosocial impact